In their recent article Gurm and colleagues (1) repeatedly used the term “benefit of vascular closure devices [VCDs]” for several subgroups, which is misleading. Observational studies cannot provide evidence of cause and effect; they can only suggest some relationship between exposure and outcome (2).

Moreover, they concluded that VCD use was associated with decreased vascular complication rates, which contradicts findings of multiple randomized trials (3, 4). Although most of these trials may have been underpowered, several meta-analyses have shown that VCD use did not decrease vascular complication rates (3, 4). Furthermore, VCD use reportedly increased the risk for groin infection and leg ischemia and the need for surgery (4).